mmpc - National Indian Health Board
mmpc - National Indian Health Board mmpc - National Indian Health Board
i. CMS stated on a couple of occasions that states have the ability to apply additional standards on QHP than the minimum standards established by CMS - Imposing a requirement that all QHP’s in a state Exchange must offer to contract with I/T/U would be allowable. ii. CMS stated they would need to issue additional formal regulations if the FFE were to impose additional requirements on QHP, such as requiring a plan to offer to contract with each I/T/U. - CMS staff also indicated that, while it is not certain and they didn’t offer to include any AI/AN-specific provisions if they do, it is likely that CMS will be issuing further formal guidance on the FFE. f. Who should tribes engage in tribal consultation with regarding Exchange operations? i. For state-based Exchanges, state officials. ii. For strictly FFE, engage CMS but no explanation was given yet of how tribes will engage CMS on state-specific issues that may apply solely to one specific state FFE (versus the discussions going on now between TTAG and CMS on the national FFE design.) iii. For Partnership exchanges, engage states on the specific functions a state may decide to operate. - Plan management (e.g., certification of QHP) - Outreach and enrollment assistance (e.g., Navigator program and “in-person assistance”) g. Liability for tax penalty for certain IHS beneficiaries - In response to questions, the IHS Director and CMS staff acknowledged that some IHS beneficiaries who choose not to purchase health insurance coverage and who do not meet the definition of Indian under the IRC definition could be liable for the tax penalty administered by the IRS for not having “creditable coverage”. h. Analysis of impact of Medicaid expansion on states 7
i. CMS rep. commented that an analysis is underway to determine the impact on each state from exercising the new Medicaid expansion option, but the analysis isn’t complete. - It wasn’t clear if CMS or another party was doing the analysis. - CMS rep. noted that it looks as if the Medicaid expansion will prove to reduce some/many state’s overall local expenditures. ii. CMS rep. cited statistics for a select number of states on the reduction in the percentage of uninsured persons in the state solely from a state exercising the new Medicaid expansion option (up to 138%). The data source was not cited. - Montana: 66% - North Dakota: 67% - South Dakota: 50% - Oklahoma: 74% - Arizona: 65% i. For non-expansion states, in response to questions raised in Anchorage and Denver -- i. CMS commented “We would be very interested in waiver proposals” from states/tribes designed to expand Medicaid coverage solely to AI/AN through I/T/U, possibly structured similar to the approved approach for AI/AN-specific benefits in Arizona. ii. CMS is considering developing a template for states to use in requesting a waiver to extend Medicaid coverage to AI/AN. j. State Plan Amendment or waiver request to CMS i. CMS emphasized that tribes in a state have the ability to request tribal consultation directly with CMS if they are not satisfied with the tribal consultation process and outcomes undertaken with the state. 8
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- Page 3 and 4: GENERAL INFORMATION TABLE OF CONTEN
- Page 5 and 6: Last Updated: November 12, 2012 2.
- Page 7 and 8: Ref. # 2. Task/Issue Person(s) CMS
- Page 9 and 10: Ref. # II. POLICY Task/Issue Person
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- Page 13 and 14: Ref. # Task/Issue Person(s) 15. Eva
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- Page 21 and 22: To do List: -Myra will have draft b
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- Page 25 and 26: with a “interim/acting”. Can al
- Page 27 and 28: 8/7/12 DRAFT COMPANION TO ADDENDUM
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- Page 31 and 32: Under federal law, There are privac
- Page 33 and 34: 1. Purpose of Addendum; Supersessio
- Page 35 and 36: (1) ISDEAA, 25 USC §450 et seq.; (
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- Page 39 and 40: edits on documents are due back fro
- Page 41 and 42: d. CCIIO Philosophy - CCIIO is taki
- Page 43: - I/T/U provider receives their all
- Page 47 and 48: IHS TRIBAL SELF-GOVERNANCE ADVISORY
- Page 49 and 50: Letter: Dr. Robert Petzel, Under Se
- Page 51 and 52: October 17, 2012 Dr. Robert Petzel,
- Page 53 and 54: A BILL To correct inconsistencies i
- Page 55 and 56: California Rural Indian Health Boar
- Page 57 and 58: As people have changes in employmen
- Page 59 and 60: Indian eligibility determinations,
- Page 61 and 62: v.7, 2012‐09‐23a ACA, (2) the s
- Page 63 and 64: Indian tribe means any Indian tribe
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- Page 69 and 70: v.7, 2012‐09‐23a Delays in acc
- Page 71 and 72: v.7, 2012‐09‐23a 1997. The prov
- Page 73 and 74: v.7, 2012‐09‐23a 48 Enacted thr
- Page 75 and 76: Prepared by James Crouch MPH Chair,
- Page 77 and 78: Summary T he Indian Health Service
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- Page 81 and 82: Introduction Reliable determination
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i. CMS rep. commented that an analysis is underway to determine<br />
the impact on each state from exercising the new Medicaid<br />
expansion option, but the analysis isn’t complete.<br />
- It wasn’t clear if CMS or another party was doing the<br />
analysis.<br />
- CMS rep. noted that it looks as if the Medicaid expansion will<br />
prove to reduce some/many state’s overall local<br />
expenditures.<br />
ii. CMS rep. cited statistics for a select number of states on the<br />
reduction in the percentage of uninsured persons in the state<br />
solely from a state exercising the new Medicaid expansion option<br />
(up to 138%). The data source was not cited.<br />
- Montana: 66%<br />
- North Dakota: 67%<br />
- South Dakota: 50%<br />
- Oklahoma: 74%<br />
- Arizona: 65%<br />
i. For non-expansion states, in response to questions raised in<br />
Anchorage and Denver --<br />
i. CMS commented “We would be very interested in waiver<br />
proposals” from states/tribes designed to expand Medicaid<br />
coverage solely to AI/AN through I/T/U, possibly structured<br />
similar to the approved approach for AI/AN-specific benefits in<br />
Arizona.<br />
ii. CMS is considering developing a template for states to use in<br />
requesting a waiver to extend Medicaid coverage to AI/AN.<br />
j. State Plan Amendment or waiver request to CMS<br />
i. CMS emphasized that tribes in a state have the ability to request<br />
tribal consultation directly with CMS if they are not satisfied with<br />
the tribal consultation process and outcomes undertaken with the<br />
state.<br />
8
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